Health Insurance Coverage in the District of Columbia: Estimates from the 2009 DC Health Insurance Survey

Abstract

This chartbook presents results from a survey of insurance status and options in the District of Columbia, conducted with 4,717 households in fall 2009. Only 6.2% of residents report being currently uninsured, among the lowest rates nationally. Somewhat more, 10.2%, report having been uninsured at some time during the year. Employer-sponsored insurance was the most common source of coverage for non-elderly adults. Among children, public coverage was nearly as important as employer-sponsored coverage. Only about 10% of publicly insured children have the option of employer-sponsored insurance. Among employed adults with public coverage, about half work in firms that offer coverage.

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Executive Summary

IntroductionThe District of Columbia is a leader in providing health coverage to its residents. Only about 6.2% of the
District population reports being uninsured. A somewhat higher share, 10.2%, report having been
uninsured at some time during the past 12 months.

Types of Insurance CoverageThe majority, 55%, of District residents have health insurance through their employers. Nearly one-third
are covered by public programs such as Medicaid, the Alliance, or Medicare. Age, race and ethnicity,
family income, employment status, and ward were all important factors associated with type of insurance
coverage. Among children, public programs are nearly as important as employer-sponsored coverage.
Among the elderly, Medicare is the most important, with supplemental coverage provided most often by
private coverage or Medicaid.

Health Insurance Options and ChoicesOnly about 10% of children with public coverage have the option of employer-sponsored insurance. In
families that have an offer of dependent coverage, higher income is associated with a greater likelihood
of children having employer-sponsored coverage. Similarly, the likelihood that adults who are offered
employer-sponsored insurance accept it rises with income. The large majority of non-elderly adults who
have public coverage are not currently employed. Of those who are employed, a little more than half
work in firms that offer insurance coverage. Most uninsured adults indicated that they would be willing to
enroll in public insurance programs, but many also indicated that they were not aware of these programs
or did not know how to enroll.

Health Care Access and UseThe majority of non-elderly adults report that they usually go to a doctor's office or private clinic for
care. But about one fifth usually go to public clinics or hospital emergency or outpatient departments,
and another fifth report that they have no usual source of care.

Introduction

The 2009 District of Columbia Health Insurance Survey (DC-HIS) was
conducted between August and November 2009 via telephone, web, and
mail by Social Science Research Solutions. It was available in English and
Spanish and took, on average, about 18 minutes to complete.

Surveys were completed with 4,717 District households. The sample
included only non-institutionalized residents and did not include homeless
residents. In order to ensure that the survey covered nearly all residents of
the District, a dual sample frame was employed, combining a random-digitdial
(RDD) sample with an address-based sample. The response rate was
43.7% for the RDD-sample and 27.3% for the address-based sample, for a
combined response rate of 34.1%.

The decision to rely on the dual-frame sample for the 2009 HIS reflects the
changing telephone environment as more and more households are relying
on cell phones, which are not called in RDD surveys. We believe this dualframe
sampling approach leads to greater confidence in the estimates of the
uninsured contained in this report.

The survey data were analyzed and charts were prepared by the Urban
Institute. For these charts, we define children as ages 0 to 18, non-elderly
adults as ages 19 to 64, and elderly adults as ages 65 and older.

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